Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Carpal tunnel syndrome is a common orthopedic disease. Western medicine treatments for carpal tunnel syndrome include conservative drug treatments, temporary external fixations, and operative treatments. Cases of patients being treated with Kampo medicine have been reported. The patient was an 80-year-old woman, who visited our clinic because of numbness in her right hand. She was diagnosed with carpal tunnel syndrome. She was administrated with a Kampo medicine, keishito. After 7 days, her symptoms were relieved, and after 14 days her symptoms had resolved. We could not find any reports showing that keishito was effective in treating carpal tunnel syndrome. We believe that her symptoms of carpal tunnel syndrome were caused by eiefuwa (nutrient-defense disharmony) and were successfully treated with keishito.

Background: In patients with fever or inflammation of unknown origin (fever of unknown origin [FUO] or inflammation of unknown origin [IUO], respectively), expert consensus recommends the use of positron emission tomography with fluorine-18-fluorodeoxy glucose combined with computed tomography (FDG-PET/CT) when standard work-up fails to identify diagnostic clues. However, the clinical variables associated with successful localization of the cause by FDG-PET/CT remain uncertain. Moreover, the long-term outcomes of patients with unexplained FUO or IUO after negative FDG-PET/CT results are unknown. Therefore, we assessed predictors of successful diagnosis of FUO or IUO caused by FDG-PET/CT and associations of spontaneous remission of symptoms with FDG-PET/CT results. Methods: All patients with FUO or IUO, who underwent FDG-PET/CT from 2013 to 2019 because diagnostic work-up failed to identify a cause, were retrospectively included. We calculated the diagnostic yield and performed multivariable logistic regression to assess characteristics previously proposed to be associated with successful localization of FUO or IUO causes. We also assessed whether the FDG-PET/CT results were associated with spontaneous remissions. Results: In total, 50 patients with diagnostically challenging FUO or IUO (35 with FUO and 15 with IUO) were assessed. Other than one case of infection, all the identified causes were either malignancy or non-infectious inflammatory diseases (each with 18 patients), and FDG-PET/ CT correctly localized the cause in 29 patients (diagnostic yield = 58%). None of the proposed variables was associated with successful localization. All 13 patients with sustained unexplained cause remained alive (median follow-up, 190 days). Spontaneous remission was observed in 4 of 5 patients with a negative FDG-PET/CT, and 1 of 8 with a positive result (P = 0.018). Conclusion In the current cohort, the proposed variables were not predictive for successful localization by FDG-PET/CT. A negative FDG-PET/CT scan may be prognostic for spontaneous remission in patients with sustained FUO or IUO.

Objective：Patients with vertebral compression fracture first visit the acute care hospital for a diagnosis, but cannot be admitted and return home with a corset and analgesics. Because of severe lower back pain, they stay in bed for a significant period of time, and their skeletal muscles suffer from disuse atrophy. We aimed to actively admit these patients for recovery phase rehabilitation by setting up a hotline.Methods：The backgrounds of each case including the major laboratory findings were investigated for 1 year. Health professionals were able to use the hotline to request admission for the patients.Results：One hundred twenty-seven patients (38 males and 89 females, aged 84±7.5 years) were admitted. The percentages of phone calls from acute-care hospitals, clinics, and regional care managers were 46%, 31%, and 20%, respectively. With regard to degree of disability 36％ of the patients were at C1, 31% were at B2, and 20% were at C2 indicating that they needed almost complete assistance. Fifty one percent of the patients lived alone, and 20% were couples without assistance from others. Because they were elderly patients with many complications, more than six agents had been prescribed on average. However, osteoporosis medication had been prescribed to only 23%. The prognosis was favorable with ratio of returned home being 91%, even though the outcome of rehabilitation is limited by ageing and deteriorated cardiac and renal functions in these patients.Conclusion：Services to support these patients during the recovery phase of rehabilitation is crucial, in order to improve community-based health care.

Background: In patients with fever or inflammation of unknown origin (fever of unknown origin [FUO] or inflammation of unknown origin [IUO], respectively), expert consensus recommends the use of positron emission tomography with fluorine-18-fluorodeoxy glucose combined with computed tomography (FDG-PET/CT) when standard work-up fails to identify diagnostic clues. However, the clinical variables associated with successful localization of the cause by FDG-PET/CT remain uncertain. Moreover, the long-term outcomes of patients with unexplained FUO or IUO after negative FDG-PET/CT results are unknown. Therefore, we assessed predictors of successful diagnosis of FUO or IUO caused by FDG-PET/CT and associations of spontaneous remission of symptoms with FDG-PET/CT results. Methods: All patients with FUO or IUO, who underwent FDG-PET/CT from 2013 to 2019 because diagnostic work-up failed to identify a cause, were retrospectively included. We calculated the diagnostic yield and performed multivariable logistic regression to assess characteristics previously proposed to be associated with successful localization of FUO or IUO causes. We also assessed whether the FDG-PET/CT results were associated with spontaneous remissions. Results: In total, 50 patients with diagnostically challenging FUO or IUO (35 with FUO and 15 with IUO) were assessed. Other than one case of infection, all the identified causes were either malignancy or non-infectious inflammatory diseases (each with 18 patients), and FDG-PET/ CT correctly localized the cause in 29 patients (diagnostic yield = 58%). None of the proposed variables was associated with successful localization. All 13 patients with sustained unexplained cause remained alive (median follow-up, 190 days). Spontaneous remission was observed in 4 of 5 patients with a negative FDG-PET/CT, and 1 of 8 with a positive result (P = 0.018). Conclusion In the current cohort, the proposed variables were not predictive for successful localization by FDG-PET/CT. A negative FDG-PET/CT scan may be prognostic for spontaneous remission in patients with sustained FUO or IUO.

Physical function measurements were obtained and the 7-item Loco-Check questionnaire for evaluation of locomotive syndrome was administered to individuals who had given informed consent at a fall prevention seminar. In total, 49 of 113 middle-aged women (age 40-69 years) with no history of fragility fracture or gait disturbance responded positive to 1 or more Loco-Check items. Multiple logistic regression analysis revealed significant association with increased body mass index (BMI), Timed-Up-and-Go delay, decreased grip strength, and aging. These findings are consistent with reports from previous research and suggest that proper maintenance of BMI, dynamic trunk balance, and grip strength are important for extension of health and vitality of the musculoskeletal system. Also, early recognition of the risk of locomotive syndrome by the Loco-Check is considered essential.

The work style of doctors gets attention within the Work Style Reforms that have been fully implemented since 2019. Now, we conducted a questionnaire survey at 10 institutions in Chugoku and Shikoku region and reviewed the latest work style of cardiovascular surgeons in comparison with other departments.

Objective：Patients with vertebral compression fracture first visit the acute care hospital for a diagnosis, but cannot be admitted and return home with a corset and analgesics. Because of severe lower back pain, they stay in bed for a significant period of time, and their skeletal muscles suffer from disuse atrophy. We aimed to actively admit these patients for recovery phase rehabilitation by setting up a hotline.Methods：The backgrounds of each case including the major laboratory findings were investigated for 1 year. Health professionals were able to use the hotline to request admission for the patients.Results：One hundred twenty-seven patients (38 males and 89 females, aged 84±7.5 years) were admitted. The percentages of phone calls from acute-care hospitals, clinics, and regional care managers were 46%, 31%, and 20%, respectively. With regard to degree of disability 36％ of the patients were at C1, 31% were at B2, and 20% were at C2 indicating that they needed almost complete assistance. Fifty one percent of the patients lived alone, and 20% were couples without assistance from others. Because they were elderly patients with many complications, more than six agents had been prescribed on average. However, osteoporosis medication had been prescribed to only 23%. The prognosis was favorable with ratio of returned home being 91%, even though the outcome of rehabilitation is limited by ageing and deteriorated cardiac and renal functions in these patients,Conclusion：Services to support these patients during the recovery phase of rehabilitation is crucial, in order to improve community-based health care.

Carpal tunnel syndrome is a common condition caused by compression of the median nerve. Patients usually present with numbness and pain along the distribution of the median nerve in the hand. We report 2 cases of carpal tunnel syndrome successfully treated with kakkonto after their pattern diagnosis. We treated a 57-year-­old women and a 59-­year-­old man. Two patients presented with hand pain and numbness and were diagnosed with carpal tunnel syndrome. Kakkonto treatment was successfully in two cases. We observed that median nerve compression persisted in these patients even after disappearance of numbness and pain ; therefore, we recommended operative management. The 2 patients underwent an operation for carpal tunnel syndrome. Kakkonto can be considered useful palliative treatment before considering operative management for numbness and pain in the patients with carpal tunnel syndrome.

BACKGROUND: The gender-specific characteristics of individuals at an increased risk of developing depression currently remain unclear despite a higher prevalence of depression in women than in men. This study clarified socioeconomic and lifestyle factors associated with an increased risk of subclinical depression in general Japanese men and women. METHODS: Study participants were residents not receiving psychiatric treatments in 300 sites throughout Japan in 2010 (1152 men, 1529 women). Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (95%CIs) for socioeconomic factors and lifestyle factors were calculated using a logistic regression analysis. RESULTS: Risk of depressive tendencies was significantly higher in men who were single and living alone (OR, 3.27; 95% CI, 1.56-6.88) than those married. The risk was significantly lower in women who were not working and aged ≥ 60 years (OR, 0.39; 95% CI, 0.22-0.68) and higher in men who were not working and aged < 60 years (OR, 3.57; 95%CI, 1.31-9.72) compared with those who were working. Current smoking was also associated with a significantly increased risk of depressive tendencies in women (OR, 2.96; 95% CI, 1.68-5.22) but not in men. CONCLUSIONS Socioeconomic and lifestyle factors were associated with an increased risk of depressive tendencies in general Japanese. Related factors were different by sex.
Adult ; Aged ; Community Psychiatry ; statistics & numerical data ; trends ; Depression ; epidemiology ; Female ; Health Surveys ; Humans ; Japan ; epidemiology ; Life Style ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; Risk Factors ; Socioeconomic Factors